Best Practices

“Keep it real” for your practice administrator

Think carefully about what you expect of the job.

By Derek Preece

“Is our administrator capable of managing this practice?”

That was the question the lead partner of a large practice posed to me. My task was to evaluate the administrator’s performance and to figure out why he didn’t seem to be keeping up with his position’s requirements.

I interviewed the administrator, finding him to be a capable, hardworking and seasoned executive. Yet some of the practice’s physician owners felt he was failing. He sensed their impatience and mentioned more than once the idea of finding other work. At one point I asked him if he kept any type of “to-do” list or work plan for himself; he answered yes and offered to email it to me.

Lots of straws on one camel’s back

After more review of the practice’s management structure and processes, I was ready to report to the board of directors. We met, with the administrator present. He was understandably nervous and not sure how the meeting would play out.

As we settled into the meeting, I asked the physicians a simple question: “How many projects can a person reasonably be expected to work on at one time?” Their answers varied, but the range was relatively small — from three to 10. I then dropped the bombshell figure I had found in the manager’s work plan: “Would it surprise you to know that Tom has 52 projects he is trying to accomplish right now?”

The doctors were stunned they had buried Tom with so many projects without any regard to how much he could reasonably take on, and that they were expecting him to make progress on everything they requested — with no prioritization and with little support. A productive discussion followed and the board reviewed his list of projects, ultimately identifying the top five for him to focus on.

These types of conflicts are playing out more frequently in ophthalmology practices across the country as regulatory and third-party payers increase their requirements, and administrators are finding it increasingly difficult to manage the complexities inherent in our health-care landscape.

Help your manager manage

So how do doctors and administrators work together to make the management workload reasonable and sustainable? Here are five steps to prevent administrator burnout and ensure your practice’s key management position doesn’t become a revolving door:

1. Set reasonable expectations for the position. Managers of a 10-doctor practice can’t be expected to know the reasons behind every insurance claim denial like they did when there was only one physician. As the practice grows, an administrator’s energy needs to be focused on larger issues such as staff training, strategic planning and budgeting, and physician recruitment and retention. Owners and managers need to take the time to define and communicate specific, reasonable expectations for the job and agree on those guidelines — an important first step in creating a workable leadership position.

2. Get help. Administrators and owners have joint responsibility to make sure they have good, capable supervisors and staff to help accomplish the practice’s workload. Overwhelmed administrators need to delegate some tasks to other employees, and if those available cannot relieve some lower-priority tasks, the administrator will never be able to work at a sustainable pace and will likely start searching the help-wanted job boards.

3. Delegate. A clear need exists for an overworked administrator, but delegation won’t work without buy-in from managers and physicians. The doctors must allow the administrator to delegate some tasks to other staff members, even if they lack the skills, competency-level and speed of their boss. Without employer support, managers will keep most of the work on their own plate and eventually burn out.

Also, the administrator has to let go of some tasks and train others to do them. This usually requires an investment of time to train the employee taking over the work, which is often difficult for a busy manager to make. But, not doing so because there’s “no time for training someone else” is a self-defeating behavior that will lead to a downward spiral of decreasing effectiveness.

4. Prioritize. In deciding which tasks to delegate, owners and managers must agree on priorities. High-priority items such as preparing for doctor meetings and recruiting new physicians will need the administrator’s personal attention; tasks that have less of an impact on the practice are good choices for delegation.

5. Communicate frequently. Once the position: is well defined with clear and reasonable expectations; appropriate help is secured to provide support; and some tasks have been delegated to other employees; the administrator and practice owners must regularly review progress and make any additional adjustments needed to create a viable management position.

Managing an ophthalmology practice today is far more difficult than it was a decade or two ago. By working together, however, physicians and managers can create reasonable expectations and a sustainable structure for their top management position and avoid the problems of burnout and turnover. OM

Derek Preece is a principal and executive consultant with BSM Consulting, an internationally recognized health-care consulting firm headquartered in Incline Village, Nev. and Scottsdale, Ariz. For more information about the author, BSM Consulting, or content/resources discusse in this article, visit www.BSMconsulting.com.